Improving and Modernizing Federal Disability Programs

An estimated one in six working-age Americans reported that they had a disability in 2010; many of them may require assistance finding or retaining employment, or rely on cash benefits if they cannot work.[1] Nevertheless, disability programs across the federal government face significant challenges in addressing the needs of Americans with disabilities. In particular, 3 of the largest federal disability programs—2 managed by the Social Security Administration (SSA) and 1 by the Department of Veterans Affairs (VA), which together dispensed about $256 billion in cash benefits to over 20 million people in fiscal year 2015—are grappling with large workloads and have struggled to make timely decisions on who is eligible for cash benefits.[2] These issues are most evident when individuals appeal their decisions, as the number of pending appeals increased 30 and 34 percent respectively at SSA and VA when comparing fiscal years 2012 and 2015. Workloads for these agencies are likely to remain a challenge as the population ages and large numbers of servicemembers are expected to transition out of the military in the next several years. In addition, SSA and VA rely on outdated criteria to determine whether individuals qualify for benefits. While these agencies reported efforts underway to update their rules, they continue to emphasize individuals’ medical conditions without sufficiently considering whether they could work because of improvements in workplace accommodations and assistive technologies. In addition to these 3 cash assistance programs, we found that there are 45 programs managed by 9 different federal agencies that provide a patchwork of employment supports to people with disabilities. Although programs that support employment can divert individuals from the disability rolls, these programs lack a unified vision, strategy, or set of goals to guide their outcomes. We first designated improving and modernizing federal disability programs as high risk in 2003.

[1] We define this measure of disability to include non-institutionalized individuals aged 21 to 64, and is based on annual U.S. Census Bureau Survey of Income and Program Participation (SIPP) data from 2010. We selected SIPP data over other available data sources because the SIPP included additional questions regarding the effect of health conditions on, for example, the respondents’ ability to work. The percent of non-institutionalized individuals of any age—or age 15 and older—with a disability is even higher. See Brault, Matthew W. “Americans With Disabilities: 2010,” Household Economic Studies (Washington, D.C.: U.S. Census Bureau, July 2012) accessed on January 7, 2017, https://www.census.gov/content/dam/Census/library/publications/2012/demo/p70-131.pdf.

[2] Comparing fiscal years 2011 and 2015, the amount of cash benefits paid by SSA’s Disability Insurance and Supplemental Security Income programs has grown from $178 billion to $196 billion; and by VA from $39 billion to $60 billion. Benefits paid under these programs are expected to continue growing for the foreseeable future. In particular, SSA’s Disability Insurance Trust Fund is projected to deplete its assets in 2023 according to the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds. This is due in part to a growing population of beneficiaries. After 2023, revenues in the Disability Insurance Trust Fund are projected to only be sufficient to pay 89 percent of Disability Insurance scheduled benefits.

This information is from GAO's 2017 High Risk Report. This report is updated every two years, at the start of each new Congress, and as needed.

The federal government’s progress in improving and modernizing disability programs remains mixed. We assessed progress across five broad areas: two reflecting SSA’s and VA’s actions to manage their disability claims workloads; two reflecting SSA’s and VA’s progress to modernize their criteria for deciding who is eligible for disability benefits; and, lastly, the Office of Management and Budget’s (OMB) efforts to create unified strategies and goals for programs that support employment for people with disabilities. Some of the agencies we assessed met certain criteria while others did not, and when combined, the resulting summary rating shows that the five criteria were partially met. SSA and VA have continued to make progress managing their claims workloads, but both agencies currently face challenges managing their appeals backlogs. SSA and VA also have made progress updating the criteria they use to determine eligibility for disability benefits, especially with respect to developing action plans. In terms of plans to mitigate the potential effects of program fragmentation, OMB—which performs a management role for the executive branch—has made some progress developing plans to test interventions that may improve employment outcomes in the private as well as public sector, but has not yet developed a unified vision, or government-wide goals and related strategies for improving employment outcomes outside of the federal sector.

With respect to SSA updating the criteria it uses to determine eligibility for benefits, more needs to be done to address this high-risk issue, but in response to our 2012 recommendation, SSA took action that resulted in cost savings. Specifically, SSA replaced its earlier, highly ambitious plans to develop its own occupational information system (OIS) (to house occupational data used to make disability determinations) with a potentially more cost-effective approach that uses existing expertise and resources in the federal government. In doing so, SSA partnered with the Bureau of Labor Statistics (BLS) to collect and update occupational information by surveying employers. As a result of SSA implementing our recommendation, we determined that, as of 2015, SSA saved approximately $27 million dollars.

This information is from GAO's 2017 High Risk Report. This report is updated every two years, at the start of each new Congress, and as needed.

Managing SSA Disability Claims Workloads: SSA should implement our past recommendation to prepare for wide-ranging management challenges by continuing to move forward with operationalizing its Vision 2025—a long-term strategic plan—to ensure that the agency is well positioned to serve its customers in the future. In addition to carefully planning and implementing systems support for initial claims, SSA should continue to implement and monitor the success of its plans for addressing the growing appeals workload and improving appeals decision timeliness.

Managing VA Disability Claims Workloads: Predicting growth in both disability compensation claims and appeals, VA should maintain focus on (1) managing its workloads at both levels; (2) ensuring that it has detailed plans in place for creating capacity and reforming its appeals process; and (3) collecting and reporting appropriate data and metrics to fully understand factors influencing timeliness under both its legacy and proposed appeals process, and transparently reporting progress.

Updating SSA Disability Benefit Eligibility Criteria: As part of its effort, SSA tasked the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine, under an existing contract, to further study the issue of how assistive technologies and workplace accommodations can affect disability determination decisions Once the study is complete in July 2017, SSA should determine if and how it can incorporate the findings into its disability decision-making process, consistent with our past recommendation. We will consider removing the area of updating SSA’s disability benefit criteria from the High-Risk List once the study is complete and SSA determines a course of action. In the meantime, we will continue to monitor SSA’s progress finalizing medical criteria and developing its OIS.

Updating VA Disability Benefit Eligibility Criteria: VA made steady progress updating its disability criteria. However, given that only a third of the initial round of updates are complete and the remainder were delayed, VA should maintain leadership focus and continue monitoring its progress against its project plans to ensure that sufficient resources are dedicated to this effort and that its plans to subsequently revisit its criteria at least once every 10 years thereafter continue to be realistic.

Ensuring Programs Have Unified Strategies and Goals: Efforts by the previous administration and OMB to improve coordination across federal programs were positive, but also limited in scope or lack funding. For example, the administration proposed an interagency council to run early intervention demonstration programs, which has the potential to uncover approaches worth pursuing at a national level. However, to date, the proposed council to achieve that vision has not been funded. Further, while common measures recently implemented will help assess the relative success of specific programs across agencies, the prior administration did not develop goals or strategies for measuring and tracking the cumulative effect of disparate programs on employment outcomes beyond the federal sector—which could also help inform and target the types of interventions to be piloted by the new administration.

This information is from GAO's 2017 High Risk Report. This report is updated every two years, at the start of each new Congress, and as needed.

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